Neonatal Arterial Ischemic Stroke – A Hospital Based Active Surveillance Study in Germany

Klemme, Mathias; Gerstl, Lucia; Weinberger, Raphael; Olivieri, Martin; Flemmer, Andreas W.; Kries, Rüdiger von; Felderhoff-Müser, Ursula; Dzietko, Mark

doi:10.1055/s-0043-104699

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…From 2015 to 2017, all paediatric hospitals in Germany (in total 345) were asked to report any case of AIS or CSVT in neonates on a monthly basis using the German Paediatric Surveillance Unit (ESPED) [4]. ESPED is a well-established surveillance system gathering data of various rare diseases in children since 1992.…”

Section: Case Ascertainmentmentioning

confidence: 99%

Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

et al. 2021

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Introduction: Relative risk, risk factors, clinical presentation, onset of symptoms, and age at diagnosis differ between arterial ischaemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in neonates. Distinguishing these 2 entities in time clinically can be of eminent importance. Methods: Active surveillance for AIS and CSVT was performed in 345 German paediatric hospitals. Only cases confirmed by cerebral MRI were included in our analysis. Patients with AIS were compared to CSVT cases with regard to age at diagnosis, pattern of clinical symptoms, and risk factors. Results: Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 (95% CI 2.1; 3.9) times higher than that of CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02) and to have signs of perinatal acidosis (e.g., umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Discussion/Conclusion: The risk for AIS is about 3 times higher than that for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data underline the need for an increased awareness of CSVT in critically ill infants.

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Section: Case Ascertainmentmentioning

confidence: 99%

Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

et al. 2021

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“…From January 1, 2015 to December 31, 2017 all 345 pediatric hospitals in Germany were asked to report any case of AIS or CSVT in infants less than 28 days of life on a monthly basis. Active surveillance (null option possible) was carried out by the German Pediatric Surveillance Unit (ESPED) monitoring rare diseases in childhood [4]. Identi cation of a case prompted a study speci c questionnaire lled out by the responsible physician to provide detailed case information.…”

Section: Case Ascertainmentmentioning

confidence: 99%

Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

Sorg¹,

Klemme²,

Kries

et al. 2020

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Background Incidence, risk factors, clinical presentation, onset of symptoms and age at diagnosis differ between arterial ischemic stroke (AIS) and cerebral sinovenous thrombosis (CSVT) in the neonate. Distinguishing these two entities early and clinically can be of eminent importance. Methods Active surveillance for AIS and CSVT was performed in 345 German pediatric hospitals. Reported cases were validated with questionnaires. Only cases confirmed by cerebral MRI were included in our analysis. Both groups of patients (AIS and CSVT) were compared with regard to age at diagnose, pattern of clinical symptoms and risk factors. Results Data on 144 AIS and 51 CSVT neonatal cases were collected from 2015 to 2017. The relative risk of AIS was 2.8 [95% CI 2.1; 3.9] times higher compared to CSVT. CSVT patients were more likely to be born premature (CSVT 14/48, 29.2%; AIS 19/140, 13.2%; p = 0.02), to have signs of perinatal acidosis (e.g. umbilical artery pH ≤ 7.1 30.2% CSVT vs. 13.5% AIS p = 0.01). Generalized seizures and lethargy were more likely to occur in infants with CSVT (p < 0.0001). Age at onset of symptoms and at time of diagnoses was shifted to older ages in CSVT (p < 0.0001). Conclusion The risk for AIS is about three times higher than for CSVT in neonates. A higher proportion of critically ill infants in CSVT and a later onset of symptoms may indicate that perinatal and postnatal risk factors are more important for CSVT than for AIS. The data point to the need for awareness of CSVT in critical ill infants.

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“…Diversity of outcome across grades of HIE is reported but only few studies have addressed the milder consequences of HIE at school age both in the pre-and post-cooling period [58][59][60] . Furthermore, children with diagnosed stroke in the neonatal period, a disease with an incidence between 7.1 in 100.000 and 16 in 100.000 live births, may also present with poor neurological and psychosocial outcome, which is largely dependent on the lesion size [61][62][63][64] . Those deficits can be attributed to the pattern of injury and affected brain structures, such as hippocampus, cortex and striatum 65 .…”

Section: Hypoxia-ischaemia (Hi)mentioning

confidence: 99%

Adverse neuropsychiatric development following perinatal brain injury: from a preclinical perspective

et al. 2018

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Perinatal brain injury is a leading cause of death and disability in young children. Recent advances in obstetrics, reproductive medicine and neonatal intensive care have resulted in significantly higher survival rates of preterm or sick born neonates, at the price of increased prevalence of neurological, behavioural and psychiatric problems in later life. Therefore, the current focus of experimental research shifts from immediate injury processes to the consequences for brain function in later life. The aetiology of perinatal brain injury is multi-factorial involving maternal and also labour-associated factors, including not only placental insufficiency and hypoxia-ischaemia but also exposure to high oxygen concentrations, maternal infection yielding excess inflammation, genetic factors and stress as important players, all of them associated with adverse long-term neurological outcome. Several animal models addressing these noxious stimuli have been established in the past to unravel the underlying molecular and cellular mechanisms of altered brain development. In spite of substantial efforts to investigate short-term consequences, preclinical evaluation of the long-term sequelae for the development of cognitive and neuropsychiatric disorders have rarely been addressed. This review will summarise and discuss not only current evidence but also requirements for experimental research providing a causal link between insults to the developing brain and long-lasting neurodevelopmental disorders.

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Neonatal Arterial Ischemic Stroke – A Hospital Based Active Surveillance Study in Germany

Cited by 5 publications

References 21 publications

Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

Clinical Diversity of Cerebral Sinovenous Thrombosis and Arterial Ischaemic Stroke in the Neonate: A Surveillance Study

Clinical diversity of cerebral sinovenous thrombosis and arterial ischemic stroke in the neonate: a surveillance study.

Adverse neuropsychiatric development following perinatal brain injury: from a preclinical perspective

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